rTMS-SENSE

Repetitive Transcranial Magnetic Stimulation (rTMS) is a form of non-invasive brain stimulation, in which magnetic pulses given to cortical regions lead to changes in brain

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circuits. rTMS is an emerging, evidence-based and safe treatment option for major depressive disorder (MDD). Response rates are estimated between 28 to 83%, depending on the protocol, cortical location, refractoriness or combined therapy. The study by Donse et al., 2018, showed that when combining rTMS with cognitive behavioural therapy (CBT) during stimulation, this has an additive effect on relieving symptoms. In their study, response (66%) and remission rates (56%) were high. The hypothesis behind this catalytic effect is that depressive networks can be coupled by cognitive tasks, after which rTMS induced neuroplasticity and its antidepressant effects may spread over networks throughout the brain during stimulation. The objective of the current study is to enhance efficacy of rTMS and improve localization of regions of interest (ROIs) using cognitive tasks during stimulation. This is a proof-of-concept study in which behavioural outcome measures and functional MRI (fMRI)

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data will be collected to assess whether and how cognitive tasks during rTMS (task induced fcMRI-rTMS) influence MDD symptoms and brain connectivity. A single-blinded, randomized, cross over design will be used including 10 adult patients, aged 18-65, with therapy resistant depression (TRD).  The study consists of two conditions. Both are treated with a high frequency 10 Hz rTMS (HF-rTMS) protocol on the left dorsolateral prefrontal cortex (dlPFC). During stimulation condition 1 will perform an adaptive n-back working memory task with pictures fearful faces and condition 2 will perform an adaptive n-back working memory task with pictures of neutral faces. The main outcome measures of this study are connectivity changes due to the different conditions and the rTMS treatment, localisation of the dlPFC, feasibility and tolerability. Connectivity changes are measured using resting-state functional MRI data. The localisation for rTMS stimulation is done using fMRI data of the dlPFC and neuronavigation. This localisation method will be compared to the Beam F3 method, which is currently used in regular rTMS treatment. The feasibility and ability to tolerate a short cognitive task during stimulation is assessed by side-effects and drop-out rates. 

 

Researcher:

Marjan Ploegaert

Karel Scheepstra

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More information: 

rTMS-SENSE studie